| Enriched Life Medical | |
|
2412 W Main St Gun Barrel City TX 75156-3638 | |
| (903) 309-9373 | |
| Not Available |
| Full Name | Enriched Life Medical |
|---|---|
| Speciality | Family Medicine |
| Location | 2412 W Main St, Gun Barrel City, Texas |
| Authorized Official Name and Position | Jon M Rich (OWNER) |
| Authorized Official Contact | 9033099373 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enriched Life Medical 2412 W Main St Gun Barrel City TX 75156-3638 Ph: () - | Enriched Life Medical 2412 W Main St Gun Barrel City TX 75156-3638 Ph: (903) 309-9373 |
| NPI Number | 1043079742 |
|---|---|
| Provider Enumeration Date | 03/15/2024 |
| Last Update Date | 11/06/2024 |
| Medicare PECOS PAC ID | 5991147589 |
|---|---|
| Medicare Enrollment ID | O20240529000085 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043079742 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jon M Rich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770520942 PECOS PAC ID: 2668478280 Enrollment ID: I20061004000544 |
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